The Timofei Moșneaga Republican Clinical Hospital (Romanian: Spitalul Clinic Republican „Timofei Moșneaga") is the oldest and largest medical institution in Moldova. It has 795 beds and 22 departments. It serves as the main clinical base for 15 departments and advanced courses of the Nicolae Testemițanu State University of Medicine and Pharmacy. It is named after former Health Minister and the hospital's longest-tenured director Timofei Moșneaga, who led the institution for over forty years..
Neuromyelitis optica spectrum disorders (NMOSD) constitute a group of rare, autoimmune and often disabling diseases of the central nervous system. Despite clear diagnostic criteria for NMOSD, diagnostic errors remain a serious problem, leading to delays in necessary treatment and adverse outcomes. This article presents four clinical cases of NMOSD that illustrate the difficulties in making a timely diagnosis due to an ambiguous clinical, radiological and laboratory picture. In these cases, clinical manifestations typical of NMOSD (optic neuritis, acute myelitis and area postrema syndrome) are described; however, the patients were initially referred to specialists in other fields: ophthalmologists, gastroenterologists and neurosurgeons, which led to a delay in their referral to the Multiple Sclerosis Centre and a late diagnosis. The delayed initiation of pathogenetic therapy in two patients led to the development of persistent severe disability as a consequence of NMOSD exacerbations. Factors contributing to the prolonged time to diagnosis were analyzed, and strategies to improve the early diagnosis of NMOSD to prevent such outcomes were proposed.
INTRODUCTION . Recurrent hiatal hernias are a separate problem of surgery. The scientific community has no generally accepted views on the indications for repeated operations for this pathology, their ideology and technical principles. The results of surgical treatment of recurrent hiatal hernias presented in the literature are also different. The OBJECTIVE was to present his own experience in the treatment of recurrent hiatal hernias. METHODS AND MATHERIALS . The article presents a ten-year experience of revision operations for recurrent hiatal hernias in 96 patients at Pavlov First Saint Petersburg State Medical University. The majority patients (56 – 58.3 %) were initially operated on in other clinics. In 31 (32.3 %) patients, the primary hernia was axial, in 37 (38.5 %) – paraesophageal or mixed type. In 28 (29.2 %) cases, the type of hernia was unknown. Primary plastic surgery using own tissues was performed in 89 patients (92.7 %), in 7 (7.3 %) – using prostheses. Indications for reoperation were not responded to drug therapy gastroesophageal reflux or food transport disorders (“gastric valve”). RESULTS . Laparoscopic access was used in 92 (95.8 %) cases, left-sided thoracotomy – in 4 (4.2 %) cases. Remote treatment results were assessed in 79 patients (82.3 %). A good outcome – absence of anatomical and clinical recurrence of the hernia – was noted in 64 cases (77.7 %). Repeated stomach dislocation into the thoracic cavity with the resumption of clinical symptoms was found in 15 patients (22.3 %). CONCLUSION . The presented data illustrate the complexity of the problem of surgical treatment of recurrent hiatal hernias and the need to search for new approaches to the solution.
BACKGROUND. The etiology of plasmacytomas in multiple myeloma (MM) remains unclear, whereas the pathogenetic mechanisms of extramedullary lesions are of particular importance because of extremely poor prognosis. The incidence of bone and extramedullary plasmacytomas complicating the course of MM as well as the efficacy of therapy for this disease are still underresearched. AIM. To assess the incidence of bone and extramedullary plasmacytomas in patients with newly diagnosed MM (ndMM) and analyze the overall survival (OS) rates depending on whether soft-tissue components were detected. MATERIALS & METHODS. This multi-center prospective study enrolled 3184 ndMM patients (1339 men and 1845 women) from 40 regions of Russia, aged 24–90 years and treated during the period from January 2015 to October 2018. The electronic patient records included demographic, clinical, laboratory, and instrumental documentation data accessible on MM diagnosis date. Bortezomib-based regimens were administered in the first-line therapy to 94 % of patients. RESULTS. Bone and extramedullary plasmacytomas were diagnosed in 763 (24 %) out of 3184 ndMM patients. At disease onset, the median hemoglobin concentration was significantly higher in patients with bone (105 g/L) and extramedullary (102 g/L) plasmacytomas than in patients without them (95 g/L; p < 0.05). The median percentage of plasma cells in the bone marrow was significantly lower in cases of bone plasmacytoma accounting for 25 % vs. 30 % in cases of extramedullary components, and it was 31 % in patients without plasmacytomas at MM onset (p < 0.05). Most commonly, plasmacytomas were detected in the thoracic spine (24.3 %; n = 132) and ribs (13.6 %; n = 74). The median OS of patients without plasmacytomas was 46 months (95% confidence interval [95% CI] 43–49 months) vs. 38 months (95% CI 42–46 months) in patients with them (p = 0.1245). The median OS was 17 months (95% CI 10–35 months) in patients with extramedullary plasmacytomas and 13 months (95% CI 1–69 months) if soft-tissue components were detected in the bones of the lower extremities. CONCLUSION. The course of ndMM is complicated by bone plasmacytomas in 23 % of cases and extramedullary plasmacytomas in 1 % of cases. The antitumor response rate as well as the OS rates are similar in patients with and without bone plasmacytomas. Extramedullary lesions in MM are associated with extremely low rate of OS with the median not exceeding 17 months.
Introduction . Timely diagnosis of life-threatening ventricular arrhythmias (VAs) is important for prescribing treatment to prevent sudden cardiac death Brief description . In the presented case, the history and multiple 24-hour electrocardiographic (ECG) monitoring data of a 26-year-old female patient with VAs in the form of frequent premature ventricular contractions and nonsustained episodes of multidirectional accelerated ventricular rhythm, nonsustained episodes of ventricular tachycardia were assessed. Physical examination was not assessed due to retrospective assessment after the patient’s death. The case study was carried out using the patient’s outpatient records from birth to 26 years, extracts from the medical history, and also based on ECG monitoring data. From the age of 14 years until the moment of fatal ventricular fibrillation, repeated studies were carried out — electrocardiography, ECG monitoring, echocardiography, as well as cardiac magnetic resonance imaging. The patient was examined in medical facilities at the regional and federal levels, received the recommended combination therapy with an antiarrhythmic effect achieved, confirmed by regular ECG monitoring. However, despite the therapy, the patient experienced ventricular fibrillation, which was recorded during 24-hour ECG monitoring on the day of death. Assessment of medication adherence is not applicable in this case due to the known outcome. Discussion . Clinical follow-up demonstrates the relevance of the prevention of sudden cardiac death in patients with diagnosed VAs, as well as the need for more frequent 24-hour ECG monitorings for the timely detection of fatal tachycardias (ventricular tachycardia, ventricular fibrillation) and determination of indications for a cardioverter-defibrillator implantation.
Background Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by widespread fibrosis of skin and internal organs. Cardiac involvement is common but often subclinical, and advanced conduction abnormalities such as complete atrioventricular block are rarely the initial manifestation.Case summary A 42-year-old man presented with fatigue and episodes of syncope. Electrocardiography confirmed complete AV block. Physical examination revealed diffuse skin tightening and Raynaud's phenomenon. Immunological testing detected high-titre antinuclear antibodies and anti-topoisomerase I, confirming diffuse cutaneous SSc. Further evaluation disclosed multiorgan involvement: high-resolution CT showed pulmonary fibrosis and right heart catheterization confirmed severe precapillary pulmonary hypertension. The patient underwent permanent dual-chamber pacemaker implantation and was started on immunosuppressive therapy and pulmonary vasodilators. On follow-up, his bradycardia resolved and exercise tolerance improved, indicating partial clinical improvement.Discussion This case highlights an atypical cardiac onset of diffuse SSc with high-grade conduction disease. It underscores the importance of considering systemic autoimmune disorders in patients with unexplained high-degree AV block, especially in the presence of characteristic skin findings. Comprehensive assessment revealed concurrent pulmonary and gastrointestinal involvement, reflecting the multisystem nature of SSc. Early recognition allowed a coordinated multidisciplinary treatment strategy, including device implantation and disease-modifying therapy, which ultimately stabilized the patient's condition. This case emphasizes the need for early diagnosis and integrated management of cardiac, pulmonary, and gastrointestinal complications in SSc. Although SSc is generally progressive, prompt recognition and treatment of organ involvement may significantly improve patient outcomes and quality of life.
